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1.
Artigo em Inglês | MEDLINE | ID: mdl-38733088

RESUMO

BACKGROUND: The role of social environment, that is, the aggregate effect of social determinants of health (SDOHs), in determining dementia is unclear. METHODS: We developed a novel polysocial risk score for dementia based on 19 SDOH among 5 199 participants in the Health and Retirement Study, United States, to measure the social environmental risk. We used a survival analysis approach to assess the association between social environment and dementia risk in 2006-2020. We further studied the interaction between social environment and lifestyles, and explored racial disparities. RESULTS: The study participants (mean age = 73.4 years, SD = 8.3; 58.0% female; 11.6% African American) were followed up for an average of 6.2 years, and 1 089 participants developed dementia. Every 1-point increase in the polysocial risk score (ranging from 0 to 10) was associated with a 21.6% higher risk (adjusted hazard ratio [aHR] = 1.21, 95% confidence intervals [95% CI] = 1.15-1.26) of developing dementia, other things being equal. Among participants with high social environmental risk, regular exercise and moderate drinking were associated with a 43%-60% lower risk of developing dementia (p < .001). In addition, African Americans were 1.3 times (aHR = 2.28, 95% CI = 1.96-2.66) more likely to develop dementia than European Americans, other things being equal. CONCLUSION: An adverse social environment is linked to higher dementia risk, but healthy lifestyles can partially offset the increased social environmental risk. The polysocial risk score can complement the existing risk tools to identify high-risk older populations, and guide the design of targeted social environmental interventions, particularly focusing on improving the companionship of the older people, to prevent dementia.


Assuntos
Demência , Predisposição Genética para Doença , Estilo de Vida , Determinantes Sociais da Saúde , Meio Social , Humanos , Feminino , Demência/genética , Demência/epidemiologia , Idoso , Masculino , Estudos Longitudinais , Fatores de Risco , Estados Unidos/epidemiologia , Idoso de 80 Anos ou mais
2.
Biomater Sci ; 12(9): 2446-2447, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38602355

RESUMO

Correction for 'Clodronate-nintedanib-loaded exosome-liposome hybridization enhances the liver fibrosis therapy by inhibiting Kupffer cell activity' by Keqin Ji et al., Biomater. Sci., 2022, 10, 702-713, https://doi.org/10.1039/D1BM01663F.

3.
BMC Geriatr ; 23(1): 700, 2023 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-37904087

RESUMO

BACKGROUND: The impact of multimorbidity on long-term care (LTC) use is understudied, despite its well-documented negative effects on functional disabilities. The current study aims to assess the association between multimorbidity and informal LTC use in China. We also explored the socioeconomic and regional disparities. METHODS: The study included 10,831 community-dwelling respondents aged 45 years and older from the China Health and Retirement Longitudinal Study in 2011, 2015, and 2018 for analysis. We used a two-part model with random effects to estimate the association between multimorbidity and informal LTC use. Heterogeneity of the association by socioeconomic position (education and income) and region was explored via a subgroup analysis. We further converted the change of informal LTC hours associated with multimorbidity into monetary value and calculated the 95% uncertainty interval (UI). RESULTS: The reported prevalence of multimorbidity was 60·0% (95% CI: 58·9%, 61·2%) in 2018. We found multimorbidity was associated with an increased likelihood of receiving informal LTC (OR = 2·13; 95% CI: 1·97, 2·30) and more hours of informal LTC received (IRR = 1·20; 95% CI: 1·06, 1·37), ceteris paribus. Participants in the highest income quintile received more hours of informal LTC care (IRR = 1·62; 95% CI: 1·31, 1·99). The estimated monetary value of increased informal LTC hours among participants with multimorbidity was equivalent to 3·7% (95% UI: 2·2%, 5·4%) of China's GDP in 2018. CONCLUSION: Our findings substantiate the threat of multimorbidity to LTC burden. It is imperative to strengthen LTC services provision, especially among older adults with multimorbidity and ensure equal access among those with lower income.


Assuntos
Assistência de Longa Duração , Multimorbidade , Humanos , Idoso , Estudos de Coortes , Estudos Longitudinais , Renda , China/epidemiologia
4.
Int J Ophthalmol ; 16(10): 1676-1681, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37854374

RESUMO

AIM: To investigate time trends in myopia and high myopia prevalence over 6y among young university adults in China. METHODS: This is a 6-year series cross-sectional study from 2016 to 2021. Totally 4910 freshmen were enrolled and completed a questionnaire concerning age, gender, and disease history. Students with eye diseases were excluded after a detailed eye examination. The refractive status was measured by non-cycloplegic objective refraction and ocular parameters were measured by Lenstar 900. The examination followed the same protocol each year. Trends over time in myopia and high myopia prevalence, as well as ocular biometry parameters, were analyzed. RESULTS: From 2016 to 2021, the axial length (AL) and corneal radius (CR) increased significantly (P=0.002 for AL; P=0.04 for CR). However, the spherical equivalent (SE) and the ratio of axial length to the corneal radius (AL/CR) did not change significantly (P=0.59 for SE; P=0.24 for AL/CR). The frequency of AL ≥26.0 mm increased from 26.6% in 2016 to 29.3% in 2021 (P=0.05 for trend). The prevalence of myopia and high myopia did not change significantly in our study (P≥0.18). Compared to a similar cross-sectional study conducted 10 years ago, the prevalence of myopia decreased significantly (94.9% vs 91.8%, P<0.001). Whereas the prevalence of high myopia increased largely (18.12% vs 27.6%, P<0.001). CONCLUSION: The prevalence of high myopia increases in young university adults during 10y period. Myopia control should begin earlier in childhood. However, these interventions are still needed for high myopia even in young adulthood.

5.
Cont Lens Anterior Eye ; 46(5): 101891, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37574330

RESUMO

OBJECTIVE: This study aimed to evaluate the visual performance and image quality of concentric dual-focus-designed contact lenses (CLs) compared with single-vision CLs in myopic Chinese people. METHODS: Twenty myopic volunteers aged between 18 and 26 years were recruited at a university eye hospital to wear both defocus-incorporated soft contact (DISC) lenses and single-vision CLs for 1 week in random order. High- and low-contrast visual acuity (VA), contrast sensitivity (CS), ocular higher-order aberrations (HOA), Strehl ratio and the Quality of Vision (QoV) questionnaire were assessed with each type of CL at weekly follow-up. RESULTS: Distance VA was not affected by DISC lenses compared to single-vision CLs in either high (p = 0.414) or low contrast (p = 0.431). However, there was a significant reduction in low-contrast near VA with DISC lenses compared with single-vision CLs (p = 0.011). The differences of CS between DISC lenses and single-vision CLs were significantly associated with lighting conditions and spatial frequencies (F = 128.81, P < 0.001). Compared with single-vision CLs, wavefront aberrations of DISC lenses were significantly increased in total HOA, trefoil, and spherical aberrations for either 3.0 mm or 6.0 mm pupil size. The Strehl ratio wearing DISC lenses reduced significantly compared to the single-vision CLs (p < 0.001) at a pupil diameter of 6.0 mm. QoV scores were higher overall (p = 0.026) and frequency (p = 0.019) with DISC lenses than with single-vision CLs, indicating poorer visual performance. CONCLUSION: DISC lenses provide satisfactory distance VA. However, the higher scores of the QoV questionnaire with DISC lenses may be related to decreased CS at medium or high spatial frequencies and increased higher-order aberrations.


Assuntos
Lentes de Contato Hidrofílicas , Miopia , Humanos , Sensibilidades de Contraste , Miopia/terapia , Transtornos da Visão , Visão Ocular , Acuidade Visual , Adolescente , Adulto Jovem , Adulto
6.
Front Public Health ; 11: 1198368, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37397721

RESUMO

Background: Failing to provide social support to cover healthcare costs for rare diseases would lead to great financial distress for the patients and their families. People from countries without a well-developed health safety-net are particularly vulnerable. Existing literature on rare diseases in China focuses on the unmet needs for care of the patients and the difficulties of caregivers and physicians. Very few studies examine the state of social safety-net, the unresolved issues and whether the current localized arrangements are sufficient. This study aimed to gain in-depth knowledge of the current policy system and make sense of the local varieties, which would be essential for developing strategies for future policy changes. Methods: This systematic policy review focuses on the provincial level policies on subsidizing the healthcare costs for people with rare diseases in China. The cut-off point for the policies was March 19, 2022. The researchers coded the healthcare cost reimbursement policies and identified the different provincial level models based on the usage of reimbursement components in each provinces reimbursement arrangements. Results: 257 documents were collected. Five provincial level models (Process I, II, III, IV and V) have been identified with the five components across the country: Basic Medical Insurance for Outpatient Special Diseases (OSD), Catastrophic Medical Insurance for Rare Diseases (CMIRD), Medical Assistance for Rare Diseases (MARD), Special Fund for Rare Diseases (SFRD) and Mutual Medical Fund (MMF). The local health safety-net in each region is a combination of one or more of the five processes. Regions vary greatly in their rare diseases coverage and reimbursement policies. Conclusion: In China, the provincial health authorities have developed some level of social protection for rare disease patients. However, there are still gaps regarding coverage and regional inequality; and there is room for a more integrated healthcare safety-net for people suffering from rare diseases at the national level.


Assuntos
Pacientes Ambulatoriais , Doenças Raras , Humanos , Atenção à Saúde , Política Pública , China
7.
Artigo em Inglês | MEDLINE | ID: mdl-37239588

RESUMO

Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups.


Assuntos
Transtornos Mentais , Humanos , Austrália/epidemiologia , Transtornos Mentais/epidemiologia , Grupos Focais , Comportamentos Relacionados com a Saúde , Saúde Mental
8.
Bull World Health Organ ; 101(5): 307-316C, 2023 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-37131938

RESUMO

Objective: To investigate the contribution of early-life factors on intrinsic capacity of Chinese adults older than 45 years. Methods: We used data on 21 783 participants from waves 1 (2011) and 2 (2013) of the China Health and Retirement Longitudinal Study (CHARLS), who also participated in the 2014 CHARLS Life History Survey to calculate a previously validated measure of intrinsic capacity. We considered 11 early-life factors and investigated their direct association with participants' intrinsic capacity later in life, as well as their indirect association through four current socioeconomic factors. We used multivariable linear regression and the decomposition of the concentration index to investigate the contribution of each determinant to intrinsic capacity inequalities. Findings: Participants with a favourable environment in early life (that is, parental education, childhood health and neighbourhood environment) had a significantly higher intrinsic capacity score in later life. For example, participants with a literate father recorded a 0.040 (95% confidence interval, CI: 0.020 to 0.051) higher intrinsic capacity score than those with an illiterate father. This inequality was greater for cognitive, sensory and psychological capacities than locomotion and vitality. Overall, early-life factors directly explained 13.92% (95% CI: 12.07 to 15.77) of intrinsic capacity inequalities, and a further 28.57% (95% CI: 28.19 to 28.95) of these inequalities through their influence on current socioeconomic inequalities. Conclusion: Unfavourable early-life factors appear to decrease late-life health status in China, particularly cognitive, sensory and psychological capacities, and these effects are exacerbated by cumulative socioeconomic inequalities over a person's life course.


Assuntos
Envelhecimento Saudável , Acontecimentos que Mudam a Vida , Criança , Humanos , China , Estudos Longitudinais , Fatores Socioeconômicos
9.
Lancet Reg Health West Pac ; 31: 100390, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36879784

RESUMO

This study aims to review China's national policies related to non-communicable disease (NCD) prevention and control at the primary health care (PHC) level since China's 2009 health system reform. Policy documents from official websites of China's State Council and 20 affiliated ministries were screened, where 151 out of 1,799 were included. Thematic content analysis was performed, and fourteen 'major policy initiatives' were identified, including the basic health insurance schemes and essential public health services. Several areas showed to have strong policy support, including service delivery, health financing, and leadership/governance. Compared with WHO recommendations, several gaps remain, including lack of emphasis on multi-sectoral collaboration, underuse of non-health-professionals, and lack of quality-oriented PHC services evaluations. Over the past decade, China continues to demonstrate its policy commitment to strengthen the PHC system for NCD prevention and control. We recommend future policies to facilitate multi-sectoral collaboration, enhance community engagement, and improve performance evaluation mechanisms.

10.
Soc Sci Med ; 320: 115670, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36669284

RESUMO

Overuse of health care is a potential factor in explaining the rapid increase in health care expenditure in many countries; however, it is difficult to measure overuse. This study employed the novel method of using unannounced standardised patients (SPs) to identify overuse, document its patterns and quantify its financial impact on patients in primary care in China. We trained 18 SPs to present consistent cases of two common chronic diseases and recorded 492 physician-patient interactions in 63 public and private primary hospitals in a capital city in western China in 2017 and 2018. Overuse, defined as the provision of unnecessary medical tests and drugs, was identified by a panel of medical experts based on national clinical guidelines. We estimated linear regression models to investigate how hospital, physician and patient characteristics were associated with overuse and to quantify the financial impact of overuse after controlling for a series of fixed effects. We found overuse in 72.15% of the SP visits. The high prevalence of overuse was similar among public and private hospitals, low-competence and high-competence physicians, male and female physicians, junior and senior physicians and male and female patients, but it varied between patients presenting different diseases. Compared to the non-overuse group, overuse significantly increased the total cost by 117.8%, the test cost by 58.8% and the drug cost by 100.3%. The financial impact of overuse was consistent across the aforementioned hospital, physician and patient characteristics. We suggest that the overuse observed in this study is unlikely to be attributable to physician incompetence but rather to the financing framework for primary care in China. These findings illuminate the cost escalation of primary care in China, which is a form of medical inefficiency that should be urgently addressed.


Assuntos
Atenção à Saúde , Gastos em Saúde , Humanos , Masculino , Feminino , China , Hospitais , Atenção Primária à Saúde
11.
Cont Lens Anterior Eye ; 46(1): 101755, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36088210

RESUMO

PURPOSE: To compare axial elongation, relative corneal refractive power (RCRP) distribution within the pupillary diameter, and corneal higher-order aberrations (HOAs) in myopic children wearing orthokeratology (ortho-k) lenses with different back optic zone diameters (BOZD). METHODS: Children aged 8-11 years were fitted with 5.0 or 6.2 mm-BOZD ortho-k lenses (groups A and B, respectively). Axial length (AL) and corneal topography were measured at baseline and during the annual visit. RCRP and corneal HOAs were compared between the two groups after one-year treatment. Multivariate linear regression analysis was performed to determine the association between AL elongation and RCRP parameters, corneal HOAs, and other variables between the groups. RESULTS: After one-year treatment, axial elongation was slower in group A than in group B, with a difference of 0.15 mm. Children in group A showed smaller treatment zone size, smaller 3/4X value (describing the distance from the apex RCRP profile rising to its three-quarter-peak level), greater RCRP sum value within the pupillary area, and higher increases in corneal total HOAs and horizontal coma (Z31). AL elongation was significantly correlated with baseline age, baseline spherical equivalent refraction (SER), treatment zone size, and 3/4X value. CONCLUSIONS: Ortho-k lenses designed with smaller BOZD increased myopia control efficacy, induced a steeper distribution of the RCRP profile within the pupillary diameter, and induced greater increases in corneal total HOAs and horizontal coma (Z31). Lens-induced RCRP profile within pupillary diameter, rising to its three-quarter-peak level at a smaller distance, may show a better myopia control effect.


Assuntos
Lentes de Contato , Miopia , Procedimentos Ortoceratológicos , Criança , Humanos , Coma , Córnea , Topografia da Córnea , Refração Ocular , Miopia/terapia , Comprimento Axial do Olho
13.
Chinese Journal of School Health ; (12): 850-853, 2023.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-976447

RESUMO

Objective@#To investigate the current situation and associated factors of computer vision syndrome (CVS) among college freshmen in Tianjin during the COVID-19 epidemic, and to provide a reference for visual comfort of college students.@*Methods@#A total of 868 college freshmen from one university in Tianjin were administered with CVS qualitative analysis questionnaire, eye health status questionnaire and eye health examination during Oct to Dec 2021. Chi square test and multivariate Logistic regression were used for data analysis.@*Results@#The detection rate of CVS among the included students was 68.5% ( n =595) and was higher in females (72.2%) than in males (61.7%). The CVS detection rate in girls, students without myopia, >30 min sleep onset, >1 h mobile phone usage, and ≤8 h sleep duration (72.2%, 70.4%, 81.1%, 72.7%, 71.2%) were significantly higher than boys, students with low grade myopia, sleep onset required ≤30 min, use mobile phone for ≤1 h, and sleep duration >8 h(61.7%, 63.3 %, 67.4%, 65.9%, 61.1%) ( χ 2=10.08, 3.94, 5.89, 4.40, 7.94, P <0.05). Differences in CVS detection rates varied significantly by daily electronic device usage and academic stress students ( χ 2=22.03, 21.24, P <0.05). Multivariate Logistic regression analysis showed that daily use of electronic devices 4-6, 7-9, ≥10 h, sleep onset required >30 min, moderate to higher academic pressure were positively associated with CVS ( OR=1.95, 2.94, 2.30, 2.39, 3.51, 4.41, P <0.05), boys, low grade myopia, night sleep time >8 h were negatively associated with CVS ( OR=0.65, 0.70, 0.65, P <0.05).@*Conclusion@#The detection rate of CVS among freshmen in a university in Tianjing is high. Attention should be paid to the CVS situation of students with e learning, and general public should also be educated to reduce the time of unnecessary electronic product use and ensure night sleep to reduce the prevalence of CVS.

14.
BMC Public Health ; 22(1): 2353, 2022 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-36522660

RESUMO

BACKGROUND: Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma. METHODS: The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. RESULTS: Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. CONCLUSIONS: We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care.


Assuntos
Formação de Conceito , Transtornos Mentais , Humanos , Pesquisa Qualitativa , Transtornos Mentais/terapia , Austrália , Grupos Focais
15.
J Clin Med ; 11(24)2022 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-36556114

RESUMO

This study aimed to explore the effect of repeated low-level red light (RLRL) on axial length (AL), choroid blood flow, and anterior segment components in myopic adults. Ninety-eight myopic adults were randomly divided into the RLRL group (n = 52) and the control group (n = 46). Subjects in the RLRL group completed a 4-week treatment composed of a 3-min RLRL treatment session twice daily, with an interval of at least 4 h. Visits were scheduled before and on 7, 14, 21, and 28 days after the treatment. AL, subfoveal choroidal thickness (SChT), choroidal vascularity index (CVI), and anterior segment parameters were measured at each visit. A linear mixed-effects model showed that the AL of the subjects in RLRL decreased from 24.63 ± 1.04 mm to 24.57 ± 1.04 mm, and the SChT thickened by 18.34 µm. CVI had a slight but significant increase in the 0-6 zone. However, all the anterior segment parameters did not change after RLRL treatment. Our study showed that the choroid's thickening is insufficient to explain the axial length shortening. The unchanged anterior segment and improved choroid blood flow suggest that the AL shortening in this study is mainly related to changes in the posterior segment.

16.
BMJ Open ; 12(11): e064641, 2022 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-36385040

RESUMO

OBJECTIVES: To measure the disease burden of ageing based on age-related diseases (ARDs), the sex and regional disparities and the impact of health resources allocation on the burden in China. DESIGN: A national comparative study based on Global Burden of Diseases Study estimates and China's routine official statistics. SETTING AND PARTICIPANTS: Thirty-one provinces of Mainland China were included for analysis in the study. No individuals were involved. METHODS: We first identified the ARDs and calculated the disability-adjusted life years (DALYs) of ARDs in 2016. We assessed the ARD burden disparities by province and sex and calculated the provincial ARD burden-adjusted age. We assessed historical changes between 1990 and 2016. Fixed effects regression models were adopted to evaluate the impact of health expenditures and health workforce indicators on the ARD burden in 2010-2016. RESULTS: In 2016, China's total burden of ARDs was 15 703.7 DALYs (95% uncertainty intervals: 12 628.5, 18 406.2) per 100 000 population. Non-communicable diseases accounted for 91.9% of the burden. There were significant regional disparities. The leading five youngest provinces were Beijing, Guangdong, Shanghai, Zhejiang and Fujian, located on the east coast of China with an ARD burden-adjusted age below 40 years. After standardising the age structure, western provinces, including Tibet, Qinghai, Guizhou and Xinjiang, had the highest burden of ARDs. Males were disproportionately affected by ARDs. China's overall age-standardised ARD burden has decreased since 1990, and females and eastern provinces experienced the largest decline. Regression results showed that the urban-rural gap in health workforce density was positively associated with the ARD burdens. CONCLUSION: Chronological age alone does not provide a strong enough basis for appropriate ageing resource planning or policymaking. In China, concerted efforts should be made to reduce the ARDs burden and its disparities. Health resources should be deliberately allocated to western provinces facing the greatest health challenges due to future ageing.


Assuntos
Recursos em Saúde , Síndrome do Desconforto Respiratório , Masculino , Feminino , Humanos , Adulto , China/epidemiologia , Efeitos Psicossociais da Doença , Envelhecimento
17.
JAMA Netw Open ; 5(8): e2228960, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-36018587

RESUMO

Importance: Falls have become a major public health issue in China with population aging. Although falls prevention for older community-dwelling people has been included in the National Essential Public Health Service Package since 2009, there is limited understanding of the implementation of this program. Objective: To identify the associated factors and provide recommendations to inform the better implementation of falls prevention in the Chinese primary health care system. Design, Setting, and Participants: This qualitative study was conducted in 3 purposively selected cities in China from March 1 to June 7, 2021. Health administrators from the local health commission or bureau, staff members from local Centers for Disease Control and Prevention and primary health care facilities and community-dwelling older people were recruited, using a combination of purposive sampling and snowball sampling. Main Outcomes and Measures: In-depth interviews were conducted with health administrators and focus groups with other participants. Data analysis followed the guidance of the Consolidated Framework for Implementation Research. Study outcomes included facilitators and barriers of implementing falls prevention for older people in the Chinese primary health care settings. A framework with recommendations was developed to inform the future intervention implementation. Results: Among a total of 130 participants interviewed, 77 (59.2%) were female and the mean (SD) age was 47.4 (16.7) years. Clear recognition of the challenges and benefits of falls prevention, adaptive regionally tailored guidance plans, and continuous governmental policy and financial support were the major facilitators, whereas the major barriers consisted of insufficient confidence in delivering interventions and poor understanding of the falls burden, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives. A 7-strategy embedded framework-including data-driven surveillance, audit and feedback, implementation strategy, workforce strengthening, community empowerment, internal services integration, and external enabling environment-was developed to foster successful implementation. Conclusions and Relevance: This qualitative study identified major facilitators and barriers to the implementation of falls prevention for older people at the primary care level, which have the potential to contribute to better implementation of falls prevention for older people in the Chinese primary health care system.


Assuntos
Acidentes por Quedas , Atenção Primária à Saúde , Idoso , China , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
18.
ACS Appl Mater Interfaces ; 14(33): 37738-37746, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-35951550

RESUMO

All-solid-state lithium metal batteries (ASSLMBs) are considered promising candidates for next-generation energy storage systems. However, the growth of Li dendrites and interface side reactions hinder the practical application of ASSLMBs. To address these issues, a preformed Li-Ag alloy anode for an ASSLMB with the Li6PS5Cl electrolyte was constructed. The preformed Li-Ag alloy anode contains two distinct alloy layers, i.e., Li3Ag and Li0.98Ag0.02, with the former as a protection layer and the latter as a Li deposition site. Besides, a beneficial stable interlayer (Ag-P-S-Cl compound) produced by the reaction between Ag and Li6PS5Cl could work as a secondary protection layer between the anode and electrolyte. The dual protection (Li3Ag and Ag-P-S-Cl compound) suppresses dendritic growth and other interfacial issues effectively and simultaneously. Consequently, a LiCoO2/Li6PS5Cl/Li-Ag all-solid-state battery exhibits a remarkable specific capacity and excellent cycle stability. The dual-protection effect from the preformed Li-Ag alloy anode and the investigation of its working mechanism may enlighten a simple strategy for promoting the development of ASSLMBs.

19.
J Colloid Interface Sci ; 621: 41-66, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35452929

RESUMO

All-solid-state metal batteries (ASSMBs) have been regarded as the ideal candidate for the next-generation high-energy storage system due to their ultrahigh specific capacity and the lowest redox potential. However, the uncontrollable chemical reactivity during cycling which directly determines the growth behaviour of metal dendrites, the low coulombic efficiency and the safety concerns severely limit their real-world applications.. Crystallographic optimization based on solid-state electrolytes (SSEs) provides an atomic-scale and fundamental solution for the inhibition of dendrite growth in metal anodes, which has attracted widespread attentions. From this perspective, we summarize the recent advance of the crystallographic optimization for various classes of solid-state electrolytes. We highlight the recent experimental findings of crystallographic optimization for a new generation of all-solid-state batteries, including lithium-ion batteries, sodium-ion batteries, magnesium-ion batteries, with the aim of providing a deeper understanding of the crystallographic reactions in ASSMBs. The challenges and prospects for the future design and engineering of crystallographic optimization of SSEs are discussed, providing ideas for further research into crystallographic optimization to improve the performance of rechargeable batteries.

20.
Adolesc Res Rev ; 7(1): 1-61, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34632045

RESUMO

Migration may lead to changing power dynamics between parents and children in families. Children may change their behavior in order to exercise agency to respond to migration of family members or themselves. This systematic review seeks to understand how children exercise agency within families in the context of migration. The authors searched ten databases to collect English-written articles published in academic journals in or after 2010. The studies were coded to generate a quality indicator. 65 Articles with moderate and strong quality were included in this review, including 41 qualitative studies, 16 quantitative studies, and 8 mixed-methods studies. Children and adolescents with demographically and culturally diverse backgrounds were analyzed in these studies. The systematic review shows that children have different levels of behavioral agency in the migration decision-making process; they also exercise agency in different aspects of family life. For example, left-behind children exercise agency in care provision and information nondisclosure, and migrant children in media and language brokering. Children's behavioral agency is place-specific. Adults working with children need to pay more attention to children's behavioral agency in order to support children's healthy development and facilitate their adaptation in the context of migration. Supplementary Information: The online version contains supplementary material available at 10.1007/s40894-021-00175-0.

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